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Graves’ Disease (Hyperthyroidism) in Children

Graves’ Disease (Hyperthyroidism) in Children

Hyperthyroidism is a disease in which the thyroid gland makes more thyroid hormone than the body needs.

This hormone helps control metabolism, the speed at which the body carries out processes like heartbeats. When the body has too much thyroid hormone, the excess can cause these processes to speed up, leading to symptoms like nervousness and weight loss. The most common cause of hyperthyroidism in the U.S. is an autoimmune disorder called Graves’ disease. Children can develop Graves’ disease, although it's less common in kids than adults.

Symptoms of Graves’ disease in children

The warning signs of Graves’ disease may be different in children than in adults. Graves’ disease can be harder to spot in kids who are normally active anyway. Parents may mistake their children’s behavior for hyperactivity or even a psychiatric condition.

You may see these symptoms of Graves’ disease in children:

An enlarged thyroid gland (this is located in the neck, just above the collarbone)

Difficulty swallowing

Prominent or bulging eyes

Weight loss or poor weight gain

Rapid pulse

Hair loss

Weakness or fatigue

Low tolerance of hot weather

Irritability and mood swings

Lack of concentration

Emotional outbursts, like crying or yelling

Rapid growth rate that slows and may ultimately lead to short stature

Mothers who have Graves’ disease may pass certain antibodies to their unborn babies, causing them to develop hyperthyroidism. Symptoms in babies include:

Rapid heartbeat

Irritability

Swollen thyroid gland

Bulging eyes

Excessive hunger

Diagnosing Graves’ disease

Health care providers can sometimes make a diagnosis of Graves’ disease based on physical symptoms, but simple tests can often confirm it. One common test for Graves’ disease is a blood test to measure the amount of thyroid-stimulating hormone (TSH) in the body. Too little TSH may indicate hyperthyroidism.

Another blood test for Graves’ disease measures molecules (antibodies) that bind specifically to pieces of the thyroid peroxidase and thyroglobulin proteins from the thyroid gland. High levels of these antibodies indicate Graves’ disease or another autoimmune thyroid disease.

Treating Graves’ disease in children

Children who are diagnosed with Graves’ disease will usually begin taking anti-thyroid medications, such as propylthiouracil and methimazole (Tapazole), to help block the production of thyroid hormone. Propylthiouracil is generally not used as first-line treatment due to increased frequency of side effects.

If your child has a serious reaction to anti-thyroid drugs, or if the drug doesn't help eliminate symptoms, radioactive iodine may be another treatment option. This oral medication destroys part or all of the thyroid gland, blocking the production of thyroid hormone.

A third treatment option is thyroidectomy, a surgical procedure to remove all or part of the thyroid. Surgery is usually done in children who have not responded well to anti-thyroid drugs or radioactive iodine. However, thyroidectomy is generally seen as a last resort. Surgery always comes with risks. It is common after thyroidectomy for the child to require thyroid hormone replacement to avoid hypothyroidism.

Outlook

People with Graves’ disease often respond well to treatment. But parents should be on the lookout for possible complications of Graves’ disease. Some people with Graves’ disease develop an eye condition known as Graves’ ophthalmopathy, which occurs when the immune system mistakenly attacks muscles and tissues around the eyes. This can happen before or after the diagnosis. Some side effects from medications can also occur. If you have concerns about complications from Graves’ disease, talk with your child’s health care provider.